Where good taste, clear and distinct ideas, and graceful modulations tend to be viewed with lowering suspicion.

Saturday, August 20, 2005

Health Savings Accounts...?

As it happens, I'm trying to sort out health insurance, and can commiserate muchly with Jeneane's predicament.

One thing I'm looking at is Health Savings Accounts - HSAs. The US Government thinks it's ok for us to deduct money we spend on healthcare from our incomes, similar to deductible IRA contributions. But you have to have a healthcare policy that offers the HSA option -- high deductible policies. (I don't see why we can't just have the accounts without the policies, but Blue Cross probably thinks that's a commie idea.) The good part is, the premiums are lower.

I am still researching HSAs. Here are some resources. I would think the US Treasury stuff, just updated, might be the most reliable source:

Oddly, the first bank I talked to -- a very big national brand -- had no knowledge of HSAs, no product to offer. Some credit unions and other financial operators do. Here's an old USA Today article that needs updating, but it shows that this concept has been around a while. Corporate enterprises may not give a fig because it's not a big moneymaker for them. At least, not yet.

A little prognostication: When millions of people have stashed lots of dollars in these accounts, banks will fall over themselves trying to grab the business.

This is not national healthcare. Maybe a stopgap. I'd be interested in any info, experiences, from those better acquainted with HSAs.

19 Comments:

Anonymous said...

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It's nice to find an actual comment among the comment spam, Harry. The Times has a way of being so arbitrarily captious that any hope of being the newspaper of record, as opposed to the newspaper of bitchmouthery, is beyond salvation. Not that I give a damn. But the author of that piece might have considered, for a moment, the plight of people like Jeneane who are paying premiums through the nose, ever escalating, with no end in sight. Suppose she could reduce her monthly healthcare vig from $1,000 to $250, and sock away $5,000 over a year in tax deferred dollars to pay out of pocket meds, dental, vision, etc. Yes, the frigging amount in the account might not pay for her or her husband's 90 days in a nursing home when they are 87. Does that eliminate the benefit of paying $9000 less a year for bullshit? There are plenty of ways these Republocrat notions can be improved. It's amusing that they produce plans that fail to capture the imaginations of their very own campaign moneybags, the large banks and financiers, because the frigging plan has too little up front holdup money to make the fuckers lift a finger. Being a USian means being mugged by contract every fucking day of your life. Only the Times could get its shorts in a wad because this sort of solution doesn't turn all muggers into Mary Poppinses.

I hadn't looked at the Times article exactly that way, Tom. I thought it was more a case of skepticism peering through the usual fit of vapors and dithering. Frankly, I was astonished that they didn't outright endorse HSAs. Though maybe they tried and all the dithering covered it up.

I have considered Jeaneane's predicament, and the predicament of people in similar situations. The HSAs can't keep up with the spiraling cost of health care unless a considerably larger portion of income is tax deductible, with increases each year, and that income exists in the first place. For someone with not outragoeus care needs, and a steady income, they're not too awful. My own stopgap solution is unlikely to implemented.

Howard Dean's Vermont healthcare model was not so very bad. It is (was) simpler than HillaryCare and could have been scaled up. It had a smart focus on early primary care, there was enough pork in it to keep the saner special interests happy and had a mildly punitive aspect for the social pseudoconservatives.

The thing that seems difficult to avoid granting is that some sort of reasonable comprehensive model - perhaps one very like Dean's - has not been undertaken in earnest. Nothing more clearly tells me the people have nothing important to do with the way their "social provisions" are devised and adopted.

for-profit healthcare is the moral equivalent of war profiteering. It is morally bankrupt and relies for its perpetuation on demonstrably false shibboleths of market efficiency, the primary importance of 'consumer choice', and capitalist incentivization. The United States stands practically alone in maintaining this barbaric let-them-eat-cake system of 'caring' for its citizens' health. When will we join civilization?BO

The Orwellian "caring" is not that difficult to see through. What corporations care about is their own economic survival. Why should healthcare corporations be different? And why should we folk be surprised that the United States of Corporate Contractual Theftcare represents with Calvinistic dedication the interests of its most prominent and powerful citizens?

Seems like the #1 need for a family is catastrophic coverage with a high overall limit, or no limit on coverage. With a deductible that is high enough cost goes down. The HSA would be a reasonable way to save money to pay the cost not covered by the deductible. But, on analogy with homeowners, Tom, the thing you have to be careful about is not routine expenses, but the catastrophe, like cancer, heart attack, or whatever else might cost hundreds of thousands. The HSA by itself does not address that. It is just "saving pp" for expenses that might be 100 times larger than the account. Then you have bankruptcy, and maybe Medicaid, if you qualify under state law. I am sure you know all this. But without catastrophic coverage you really don't have much in the way of "insurance" against major loss.

Tutor: I'm in complete agreement. Only thing is, as I'm sure you know better than I, at the moment the private plans set premiums based on vagaries of their particular plight, including: the size, relative health, age, education, etc. of their pools of insured, along with other actuarial data, regulatory environments, and the degree of success of their business, which is in turn dependent in turn upon a host of economic and personnel factors and decisions, etc.

What I was envisioning was not doing without catastrophic, but rather enlarging the pool to include the general population, and still giving us some tax incentives to deal with non-catastrophic care.

Would something of the sort make sense to people in the industry (other than that it would mosty eliminate their reason for being)?